CDC Releases Updated Estimates on New HIV Infections

CDC on Saturday ahead of the XVII International AIDS Conference, which opened Sunday in Mexico City, released updated national estimates of the annual number of new HIV infections that occur in the U.S., the Washington Post reports (Brown, Washington Post, 8/3). The new data were published Sunday in a special HIV/AIDS issue of the Journal of the American Medical Association, which was released at the AIDS conference (CDC release, 8/3).

The new analysis found there were about 56,300 new HIV infections in 2006, the most recent year for which data are available, about 40% higher than CDC's long-standing estimate of 40,000 for each of the last several years (Washington Post, 8/3). According to CDC, the number of new infections likely was never as low as the previous estimate of 40,000 and has been relatively stable overall since the late 1990s (CDC release, 8/3). According to the Post, the estimate is based on data from a new advanced testing method, which enabled researchers to detect recent HIV infections (Washington Post, 8/3). The study did not calculate the total number of U.S. residents living with HIV/AIDS, although such estimates are expected soon. Earlier projections estimated that about 1.2 million people in the U.S. are HIV-positive, and CDC is updating that number, the Boston Globe reports (Smith, Boston Globe, 8/3).

People in their 30s had the highest number of new HIV infections, while people younger than age 30 accounted for 34% of all new infections;

73% of new infections were recorded among men (Washington Post, 8/3);

Injection drug users accounted for 12% of infections; and

Heterosexuals made up 31% of new infections.

Although the report indicates general stability in new infections nationally, as well as reductions in new infections among both IDUs and heterosexuals over time, it also shows increases among MSM (CDC release, 8/3).

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HIV incidence in 2006 among blacks was 83.7 infections per 100,000 people, seven times as high as the rate of 11.5 per 100,000 among whites and three times as high as the 29.3 infections per 100,000 people among Hispanics (Altman, New York Times, 8/3). According to the data, although new infections among blacks are higher than among any other racial or ethnic group, the number has been relatively stable since the early 1990s (CDC release, 8/3).

Historical Analysis According to the analysis, new HIV infections peaked at about 130,000 annually in the mid-1980s and decreased to a low of about 50,000 annually in the early 1990s. The number of new infections increased in the late 1990s and has been relatively stable since then, with estimates of between 55,000 and 58,500 new infections annually in the three most recent time periods that were analyzed, according to the study (New York Times, 8/3).

Prevention, Funding According to the Post, CDC spends about $750 million each year on prevention efforts. About half of CDC's HIV prevention budget targets blacks, Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said. However, he added that the increasing incidence in MSM -- particularly in young black MSM -- is evidence that prevention campaigns have "not reached all those who need it" (Washington Post, 8/3).

According to Fenton, the recent relative stability in incidence is somewhat good news because the overall number of people living with HIV who could potentially pass the virus on to others is increasing as HIV-positive people are able to live longer due to antiretroviral drugs. That suggests those people are taking steps to prevent spreading the virus, the San Francisco Chroniclereports (Stannard, San Francisco Chronicle, 8/3). "Over 95% of people living with HIV are not transmitting to someone else in a given year," David Holtgrave of the Bloomberg School of Public Health at Johns Hopkins University said, adding, "What that says is the transmission rate has been kept very low by prevention efforts" (Washington Post, 8/3).

An analysis last year by Holtgrave and Jennifer Kates, a Kaiser Family Foundation vice president and director of HIV policy at the foundation, showed a correlation between the amount of funds spent on prevention and HIV incidence. "You get what you pay for," Holtgrave said, adding, "I think the new statistics are the most important AIDS story in the U.S. since the advent of the new treatments" (USA Today, 8/3).

Comments According to the Globe, the fact that more people than previously thought might have contracted HIV since the late 1990s will have "profound consequences" for physicians, policymakers and HIV/AIDS advocacy groups (Boston Globe, 8/3).

CDC Director Julie Gerberding said that the new data likely will influence decisions about efforts to control the epidemic. She added that although HIV incidence is "certainly too high," it is "stable." According to Gerberding, a "stable number of new infections in a world that has got more and more people with HIV and people with AIDS living in it suggests that we are keeping up with that pressure for transmission" (New York Times, 8/3).

Several HIV advocates expressed anger at CDC's delay in releasing the data, which were available in October 2007 when the agency completed the study, the Wall Street Journal reports. UNAIDS Director Peter Piot said that "timely information is important for prevention." Kate Krauss, a spokesperson for Physicians for Human Rights, said, "Science-based AIDS prevention means having access to accurate data about how many people are becoming infected," adding, "Without it we are shooting in the dark" (Chase, Wall Street Journal, 8/4).

The agency's delay in releasing the data also has fueled criticism that the Bush administration has not done enough to fight HIV/AIDS in the U.S., according to the Times. Rep. Henry Waxman (D-Calif.) said HIV prevention efforts have been "underfunded and too often hindered by politics and ideology," adding that, when adjusted for inflation, the administration's domestic spending on HIV/AIDS has decreased by 19% since 2002. Waxman also said he plans to hold congressional hearings on why CDC has had "less and less money to actually get [HIV prevention] programs to the communities that need them."

Gerberding responded to the criticism, saying that the data have "been scrutinized by some of the best statisticians in the country and is much better now than when we started this process" (New York Times, 8/3). Gerberding added that the new data represent the "most reliable estimate" since the "beginning of the epidemic" (Stobbe, AP/San FranciscoChronicle, 8/3).

Fenton said, "It's important to note that the new estimate does not represent an actual increase in the number of new infections but reflects [CDC's] ability to more precisely measure HIV incidence and secure a better understanding of the epidemic" (CDC release, 8/3). However, Fenton added that the "fact remains that there are far too many people becoming infected in the United States every year. Therefore, these findings should be a wake-up call ... that the epidemic in the United States is far from over" (San Francisco Chronicle, 8/3).

Comments From Presidential Candidates Presumptive presidential candidates Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) on Sunday in response to the new estimates pledged to increase the fight against HIV in the U.S., AFP/Google.com reports. Obama said that if elected president, he would develop a national strategy to reduce new infections, expand testing and education, and eliminate stigma. McCain vowed to reduce drug costs, as well as to target testing and prevention in highly affected communities.

"These new figures should bring new focus to our efforts to address AIDS and HIV here at home," Obama said in a statement, adding that the focus should be on "expanding access to testing and comprehensive education programs." The fight against HIV/AIDS also "demands closing the gaps in opportunity that exist in our society so that we can strengthen our public health," Obama said, adding, "We must also overcome the stigma that surrounds HIV/AIDS -- a stigma that is too often tied to homophobia."

McCain in a statement said that if elected, he would "work closely with non-profit, government and private-sector stakeholders to continue the fight against HIV/AIDS." He added, "By focusing efforts on reducing drug costs through greater market competition, promoting prevention efforts, encouraging testing, targeting communities with high infection rates, strengthening research and reducing disparities through effective public outreach, we as a nation can make great progress in fighting HIV/AIDS" (AFP/Google.com, 8/3).

More Comments Kates said the new data "corroborate what many" HIV/AIDS researchers "suspected -- that the epidemic is worse than we thought" but that it "doesn't seem to be getting worse" (Washington Post, 8/3).

Mark McLaurin of the Community HIV/AIDS Mobilization Project said the new estimate "means little if it does not serve as the spark to inflame our collective anger about the deadly neglect of an acute emergency" (Fox, Reuters, 8/2).

Michael Weinstein, president of the AIDS Healthcare Foundation, said, "There is absolutely no good news here. Without an accurate picture of the epidemic, vastly underestimated for the last 10 years, we have missed countless opportunities to intervene with effective public health strategies."

Phill Wilson, founder and CEO of the Black AIDS Institute, added that the new figures "confirm that AIDS in America is a black disease and has been neglected for far too long" (Maugh, Los Angeles Times, 8/3).

A kaisernetwork.org interview with Fenton is available online. Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.

Multimedia Coverage CBS' "Evening News": The program on Saturday reported on the study and included comments from Fenton and Sean Barry of the New York AIDS Housing Network (David, "Evening News," CBS, 8/2).

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